Health: Academic Health Partnerships

Lord Butler of Brockwell Excerpts

Monday 29th November 2010 Lords Chamber

[Lord Kakkar]

My Lords, I congratulate the noble Baroness, Lady Finlay of Llandaff, on having secured this important debate. I declare my own interest as a clinical academic and chairman for clinical quality at UCL Partners academic health science centre.

Healthcare systems around the world are facing considerable challenges. We know that in developing countries there is now an epidemic of diseases not previously experienced in those countries, such as diabetes, obesity, cardiovascular disease and so on. In our own healthcare system, we face similar challenges from chronic diseases that will need to be managed in an effective way, frequently with attention on prevention rather than just on treatment. We also still face serious disparities in access to healthcare, clinical outcomes, escalating costs for healthcare and variable quality across the healthcare system, as we have seen this past weekend with the publication of the Dr Foster report on adverse events experienced throughout the healthcare system in England.

Over the past 50 years, many of the advances that have helped us to improve outcomes and the quality of care that we provide to patients have been academically led. There is a growing recognition that the contribution of academic medicine is potentially even greater now than in previous decades because the challenges that we face are much greater. As we have heard, there is a developing movement throughout the world, certainly in mature healthcare systems, for the development of academic health science centres, which are well placed to face the challenges that have been identified as the pathway of discovery care. That continuum needs to be bridged to ensure that research activity, stimulated by endeavour, careful thought and intellectual enterprise, can be converted into new interventions, therapies and systems and into pathways of healthcare to improve clinical outcomes.

It is now well recognised that there are two important gaps that academic medicine and institutions can overcome in this discovery care continuum. The first is the gap characterised as “from bench to bedside”, taking those discoveries and having appropriate translation medicine to ensure that those discoveries can be tested and presented to the wider clinical audience—clinical colleagues and other healthcare professionals, as we have heard—in such a way that they might be adopted to improve clinical care and outcomes.

The second gap is to move from a very difficult place where there is expert acceptance of the discoveries and their evaluation from basic and clinical research, and to ensure that those are broadly adopted. Indeed, it is quite shocking—here I must declare a further interest as director of the Thrombosis Research Institute in London, which is involved in many collaborative research programmes with industry in the area of thrombosis—that this weekend we saw, in the Dr Foster analysis of adverse events in our healthcare system, some 62,800 reported adverse events, 30,500 of which were deep-vein thrombosis or pulmonary embolism. That is quite striking as we have known for over 30 years, thanks to research, much of which was conducted in the institute that I am now director of, that there are simple ways to assess patients at risk of thromboembolism and simple methods that can be applied to those at risk to reduce their risk of developing a blood clot while in hospital or soon after being discharged. It is well recognised by experts. We have guidelines. Indeed, we have the active programme from the Department of Health in this area. There is still a gap, however, in its widespread adoption. I very strongly believe that academic health science systems have an important role to play in overcoming this gap and ensuring that what we understand can be applied not only in single institutions but broadly across healthcare systems to improve clinical outcomes, and in ensuring that the research effort is properly applied to benefit the largest number of potential patients.

We have also heard that there are important economic benefits to be derived from having a strong academic clinical base. One of the purposes of the five academic health science centres, which we have heard about previously in this debate, is to ensure that the United Kingdom remains an important target for inward investment by the bio-pharmaceutical industry for research and that the opportunity to collaborate with industry delivers not only clinical benefit for our patients but economic benefit for our country.

Will the Minister confirm—I am sure this is the case—that academic health science centres remain at the very heart of Her Majesty’s Government’s agenda for healthcare and ensuring that we can achieve the very best clinical outcomes, quality, access and value in our healthcare system? Will he also confirm that the opportunity will be taken to explore whether the remit of academic health science centres can be explored so that they focus much more on becoming academic health science systems across entire sectors or health economies, driving the potential for broader integration—both vertical integration across primary, secondary and tertiary care, and horizontal integration, as we have done at UCL Partners—in developing provider networks that are focused not on the outcomes that an individual institution can achieve but on the outcomes that are achievable across the entire patient pathway and are focused on improving clinical outcomes for the continuum of care, particularly for the management of patients with chronic conditions? Will he also confirm that we will look at how academic health science systems can facilitate primary care commissioning as that moves forward and is developed in the coming years, and that we will continue to ensure that the contributions that the United Kingdom can make globally to academic health science systems and centres are maintained and that our country continues to benefit from participation in those systems and centres?

[Lord Butler of Brockwell]

My Lords, I, too, thank the noble Baroness, Lady Finlay, for the opportunity to discuss what I think is a very exciting and positive feature of our national scene: the partnership between academic and health activity. It is also a pleasure to follow my noble friend Lord Kakkar, whose professional interests, as he has explained, lie in north London but whose personal interests lie, like mine, in south London.

The question asked by the noble Baroness, Lady Finlay, is how the Government propose to preserve academic health partnerships. I should declare an interest as chair of King’s Health Partners, one of the five national AHSCs about which the noble Baroness, Lady Donaghy, has already spoken so fluently. Indeed, I endorse everything that she said. The noble Baroness, Lady Finlay, was right to emphasise the great advantages that Britain has in contributing academic research to medicine and how this country punches above its weight in those areas. As the noble Lord, Lord Kakkar, said, this is not only a benefit to health treatment but an enormous economic benefit through the investment of big pharma in this country. Perhaps that investment is second only to financial services in its importance to the economy of the country. But it is fragile, and we have already seen some signs of that fragility with GSK’s decision to move many of its activities to Shanghai and Merck’s departure. We must strive to maintain this country’s attraction for big pharmaceutical companies. It is very reassuring that the Government recognise that. The emphasis on the importance of research in the Government’s White Paper is also greatly welcome.

As other speakers have said, the five AHSCs are among the most valuable instruments for bringing together academia and the National Health Service, which might, as the noble Lord, Lord Alderdice, said, have drifted away from each other somewhat in the past 15 years. I pay tribute to the steps that the previous Government took to reverse that trend, not least by establishing the AHSCs. To reflect on the partnership with which I am associated, what does that partnership bring together? In King’s College London, it brings an outstanding research university and a leading medical training institution; in Guy’s and St Thomas’ and King’s College Hospital, it brings two of the world’s leading teaching and clinical care hospitals; and in the South London and Maudsley Hospital, it brings one of the nation’s leading psychiatric hospitals.

I invite the House to consider what we can achieve in modern healthcare by closer links between those institutions. First, as has been mentioned, we can bring research and clinical care closer together, and accelerate the translation of the very exciting discoveries that are made all the time in research to the care of the patient.

Secondly, there can be a closer link between mental and physical care. I particularly emphasise this in the case of the partnership with which I am associated. It is a weakness of our present system that psychological morbidity in patients with physical illness and physical morbidity in patients with mental illness have not been sufficiently recognised and addressed.

Thirdly, there are the integrated pathways of care for patients. This is, I think, very close to the Government’s heart and their policy in the White Paper. Like the other two London AHSCs, King’s Health Partners is working with local GPs and local authorities to establish new models of preventive medicine and community care, as well as tertiary care.

Finally, there can be more effective medical training not only through the university and teaching hospitals but in the community through the health innovation and education cluster—the HIEC—for which King’s Health Partners has been given the lead for south London.

This link between research and clinical treatment is personified in the chief executive of King’s Health Partners, Professor Robert Lechler. He is not only a distinguished researcher and clinician at Guy’s Hospital but vice-principal of the university. This link is repeated in many others who hold joint appointments in the university and member hospitals. The challenge for the AHSCs is to realise the opportunities that these existing links represent.

As has been mentioned, the previous Government, in setting up the AHSCs, did not give them any extra funds, unlike the Dutch Government, who recognise the importance of their equivalent of AHSCs through higher-intensity payments for them. Despite the lack of a financial incentive, when I came into this work, I, like others who have spoken, was hugely impressed by the enthusiasm and commitment not only of the four partner institutions in the AHSC with which I am associated but also—again, this has been mentioned—among the world-renowned researchers and clinicians who form part of them. This really is a movement that is supported at the grassroots level by those who work in the field. Like others, I hope the Minister will be able to say tonight that the Government endorse the objectives that I have described and see AHSCs as crucial to achieving them.